新生儿细菌性肺炎82例高危因素分析及防治

Risk factors for bacterial pneumonia in neonates and the protective measures:A report of 82 cases

目的：探讨新生儿细菌性肺炎发病的高危因素和防治方法。方法：对2004-2005年发病的新生儿82例早期、晚期细菌性肺炎高危因素、痰培养及药敏结果作一回顾性分析。结果：胎膜早破、窒息、低体温、气管插管、机械通气、早产和羊水污染等危害因素在新生儿肺炎早期发病组（≤7天发病）均高于晚期发病组（〉7天发病）（P〈0.05-P〈0.01）;上呼吸道感染病史或接触史在新生儿早期发病组低于晚期发病组,两者差异有统计学意义（P〈0.01）;不当沐浴、捂热在新生儿早期发病组及晚期发病组所占比例均无统计学意义（P〉0.05）;G^-杆菌是细菌性肺炎的主要致病菌,克雷伯杆菌居于首位（25.61%）,其余致病菌中链球菌为24.39%,肠杆菌为13.41%,假单胞菌为13.41%,沙雷菌为10.98%,大肠埃希菌为3.66%。呼吸机相关性肺炎（VAP）占12.20%。结论：进一步加强围产期保健和新生儿转运系统的建设,早产儿尽量实行“宫内转运”,重视VAP的防治,做好新生儿家庭保健宣教,对于减少细菌性肺炎的发生有着重大意义。

Objective ：To analyze the risk factors for bacterial pneumonia in neonates and to find the protective measures. Methods： The risk factors, sputum-culture and drug-sensitivity of 82 infants with bacterial pneumonia were analyzed retrospectively. The samples were collected from January 2004 to January 2005. Results： The incidence of fetal membrane premature rupture, asphyxia, low- temperature, ventilation, premature delivery and pollution of mnniotic fluid was higher in the early-onset pneumonia group than that of late-onset group. Fewer infants had upper respiratory infection or contact history in the early-onset group. There was no significant difference between the two groups in the incidence of non-proper bath or muggy syndrome （ P 〉 0. 05 ）. Gram-negative bacteria （70.73%） were the main organisms in the bacteria pneumonia. Klebsiella （25.61%）was the most common bacterium. The other pathogenic bacteria were Streptococcus （ 24. 39% ） , Enterobacter （ 13. 41% ）, Pseudornonas （ 13.41% ）, Salmonella （ 10.98% ） and Escherichia coli（3.66% ）. Ventilation-associated pneumonia （VAP） accounted for 12.20%. Conclusions： Intensive health care in perinatal period,intrauterine transportation for premature infants, prevention and treatment of VAP, and health education to the parents are essential for the prevention of bacterial pneumonia in neonates.